| NPI | 1245269513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: NC 200000677) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 2000-00677) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2021-04-01 |