| NPI | 1174825814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MD D0087690) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: PA MT196417) |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: PA MD470885) | |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: MD D0087690) | |
| 2084P2900X Psychiatry & Neurology Pain Medicine (Licence: MD D0087690) | |
| 208VP0000X Pain Medicine Pain Medicine (Licence: PA MD470885) | |
| Enumeration Date | 2010-12-01 |
| Last Update Date | 2024-10-02 |