| NPI | 1205028149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: PA MD441308) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD441308) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME162732) | |
| Enumeration Date | 2007-08-14 |
| Last Update Date | 2026-06-02 |