| NPI | 1467411975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME57494) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: FL ME57494) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL ME57494) | |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: KY 55967) | |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: NM MD2021-1162) | |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: FL ME57494) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: FL ME57494) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL 57494) | |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2022-07-28 |