| NPI | 1679716344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: FL ME120029) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME120029) |
| 208VP0000X Pain Medicine Pain Medicine (Licence: FL ME120029) | |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: FL ME120029) | |
| Enumeration Date | 2009-04-10 |
| Last Update Date | 2025-01-10 |