| NPI | 1295818409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: GA 101776) |
| Additional Taxonomies | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: TN 47683) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2025-09-22 |