| NPI | 1235278458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P2900X Psychiatry & Neurology Pain Medicine (Licence: CT CT013059) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CT CT013059) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2011-03-15 |