| NPI | 1619919529 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL ME100763) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME100763) |
| 207LA0401X Anesthesiology, Addiction Medicine (Licence: FL ME100763) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL ME100763) | |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: FL ME100763) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: FL ME100763) | |
| 225100000X Physical Therapist (Licence: FL ME100763) | |
| 261QM2500X Clinic/Center, Medical Specialty | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2023-05-11 |