| NPI | 1174740419 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: RI LP00996) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: PA MD439937) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2013-01-11 |