| NPI | 1487919759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL ME129977) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME129977) |
| 208100000X Physical Medicine & Rehabilitation (Licence: PA MD450453) | |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2024-02-14 |