| NPI | 1114591112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 5151014774) |
| Additional Taxonomies | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: MI 5101027618) |
| Enumeration Date | 2021-05-14 |
| Last Update Date | 2025-04-14 |