| NPI | 1225356678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 71854) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 343083) |
| 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: CA 456) | |
| Enumeration Date | 2010-05-10 |
| Last Update Date | 2024-04-01 |