| NPI | 1952345324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME84093) |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine (Licence: FL ME 84093) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2011-09-15 |