| NPI | 1457351322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL ME93866) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: FL ME93866) |
| 208100000X Physical Medicine & Rehabilitation (Licence: FL ME83866) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL ME93866) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: FL ME93866) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: FL ME93866) | |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2022-04-12 |