| NPI | 1720074610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: FL ME104540) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL ME104540) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME104540) | |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2019-05-29 |