| NPI | 1669664579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL ME112766) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: FL ME112766) |
| 207R00000X Internal Medicine (Licence: FL ME112766) | |
| Enumeration Date | 2007-08-14 |
| Last Update Date | 2014-08-08 |