| NPI | 1447484852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME141947) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: NY 276031) |
| 2084P2900X Psychiatry & Neurology Pain Medicine (Licence: FL ME141947) | |
| Enumeration Date | 2009-05-13 |
| Last Update Date | 2024-03-06 |