| NPI | 1386606325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME0038969) |
| Additional Taxonomies | 208VP0000X (Licence: FL ME38969) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL me0038969) | |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2018-12-10 |