| NPI | 1467608521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME121020) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: FL ME121020) |
| 208M00000X Hospitalist (Licence: FL ME121020) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: FL ME121020) | |
| Enumeration Date | 2008-08-08 |
| Last Update Date | 2018-10-31 |