| NPI | 1376740191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: FL ME115646) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME115646) |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2022-08-30 |