| NPI | 1861789992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: FL ME127695) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: GA 072551) |
| 208100000X Physical Medicine & Rehabilitation (Licence: FL ME127695) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: GA 072551) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL ME127695) | |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: FL ME127695) | |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: GA 072551) | |
| 208VP0000X (Licence: GA 072551) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: GA 072551) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL ME127695) | |
| Enumeration Date | 2011-07-11 |
| Last Update Date | 2024-06-18 |