| NPI | 1538135132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME0041659) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL FL ME0041659) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: FL ME0041659) | |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2018-12-31 |