| NPI | 1790996627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RR0500X Internal Medicine Rheumatology (Licence: FL ME102955) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: FL ME102955) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2023-10-19 |