| NPI | 1376705681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: FL ME122905) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: LA MD.207042) |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: FL ME122905) | |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2024-05-20 |