| NPI | 1972914869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: FL ME135621) |
| Additional Taxonomies | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: IL 036148150) |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2022-05-31 |