| NPI | 1639163017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME131650) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: FL ME131650) |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2019-12-18 |