| NPI | 1609211879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: FL ME122075) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME122075) |
| Enumeration Date | 2013-05-01 |
| Last Update Date | 2024-07-12 |