| NPI | 1902880933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL ME72561) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME72561) |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: FL ME72561) | |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2024-02-06 |