| NPI | 1679865695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: FL ME128640) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME128640) |
| 208100000X Physical Medicine & Rehabilitation (Licence: PA MT199120) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: WV 26582) | |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: FL ME128640) | |
| Enumeration Date | 2011-05-10 |
| Last Update Date | 2024-02-14 |