| NPI | 1295750800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL ME0060908) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME0060908) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2023-05-23 |