| NPI | 1255954194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: NC 2025-00853) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: SC LL84068) |
| Enumeration Date | 2020-05-27 |
| Last Update Date | 2025-04-21 |