| NPI | 1609803832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL ME125319) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME125319) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL ME125319) | |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2018-02-23 |