| NPI | 1801320148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: FL ME137842) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: FL ME137842) |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: FL ME137842) | |
| Enumeration Date | 2017-04-13 |
| Last Update Date | 2024-12-16 |