| NPI | 1811253057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: FL ME127804) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME127804) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL ME127804) | |
| Enumeration Date | 2012-04-02 |
| Last Update Date | 2021-02-23 |