| NPI | 1073977328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P2900X Psychiatry & Neurology Pain Medicine (Licence: FL ME156490) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: MD D90123) |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: DC MD048474) | |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: VA 0101269788) | |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2022-07-06 |