| NPI | 1770875700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL ME125276) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: FL ME125276) |
| 207R00000X Internal Medicine (Licence: FL TRN16049) | |
| 207L00000X Anesthesiology (Licence: FL ME125276) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: FL ME125276) | |
| Enumeration Date | 2011-05-10 |
| Last Update Date | 2022-04-27 |