| NPI | 1619266806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME130341) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: NC 2016-00936) |
| 207L00000X Anesthesiology (Licence: NC 2016-00936) | |
| Enumeration Date | 2011-03-29 |
| Last Update Date | 2023-04-06 |