| NPI | 1548795644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL 32446) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: FL ME157775) |
| 208100000X Physical Medicine & Rehabilitation (Licence: FL ME157775) | |
| Enumeration Date | 2017-04-26 |
| Last Update Date | 2024-10-09 |