| NPI | 1659699460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME167163) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 32551) |
| 207Q00000X Family Medicine (Licence: CT 54678) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: FL ME167163) | |
| Enumeration Date | 2010-05-05 |
| Last Update Date | 2024-09-17 |