| NPI | 1164547709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NM 93-208) |
| Additional Taxonomies | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: NM 93-208) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: NM 93-208) | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2019-02-22 |