| NPI | 1871800664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: FL ME108115) |
| Additional Taxonomies | 207QA0505X Family Medicine Adult Medicine (Licence: FL ME108115) |
| 208000000X Pediatrics (Licence: FL ME108115) | |
| 2080P0204X Pediatrics Pediatric Emergency Medicine (Licence: FL ME108115) | |
| 261QU0200X Clinic/Center Urgent Care (Licence: FL ME108115) | |
| Enumeration Date | 2010-09-01 |
| Last Update Date | 2024-05-23 |