| NPI | 1619996063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: ME 1984) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: NH 18970) |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NH 18970) | |
| 207R00000X Internal Medicine (Licence: ME 1984) | |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: NH 18970) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2023-07-17 |