| NPI | 1902019979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL ME119806) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL ME119806) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: FL ME119806) | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2021-12-29 |