| NPI | 1013906833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 83482) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: GA 83482) |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: GA 83482) | |
| 207L00000X Anesthesiology (Licence: WA MD60035970) | |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2020-08-07 |