| NPI | 1053660886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CA A142095) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NY 268942) |
| 208VP0000X Pain Medicine Pain Medicine (Licence: FL ME134702) | |
| Enumeration Date | 2012-09-07 |
| Last Update Date | 2024-02-08 |