| NPI | 1508480591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL ME157981) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME157981) |
| Enumeration Date | 2020-06-04 |
| Last Update Date | 2025-01-29 |