| NPI | 1558541839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: FL ME 126938) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME 126938) |
| 207Q00000X Family Medicine (Licence: FL ME 126938) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: FL ME 126938) | |
| Enumeration Date | 2007-11-05 |
| Last Update Date | 2018-09-05 |