| NPI | 1063752509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: CA 136156) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 136156) |
| Enumeration Date | 2013-02-20 |
| Last Update Date | 2021-04-23 |