| NPI | 1063625119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME117122) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX M6472) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX M6472) | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2018-07-05 |