| NPI | 1548754989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: FL ME176129) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL ME176129) |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2025-08-15 |