| NPI | 1750310223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL ME148837) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NH 17334) |
| 208100000X Physical Medicine & Rehabilitation (Licence: FL ME148837) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2024-08-22 |