| NPI | 1407870736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL ME73546) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: FL ME0073546) |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: FL ME73546) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2022-05-12 |