| NPI | 1487819686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL ME137943) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MA 257452) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MA 257452) | |
| Enumeration Date | 2008-07-28 |
| Last Update Date | 2018-11-24 |