| NPI | 1194384743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 1025636) |
| Additional Taxonomies | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: MA 1025636) |
| Enumeration Date | 2019-06-07 |
| Last Update Date | 2026-06-02 |