| NPI | 1255603809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 28031) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 28031) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: MO 28031) | |
| Enumeration Date | 2012-01-29 |
| Last Update Date | 2012-01-29 |