| NPI | 1295819993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 29699) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: NC 29699) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: NC 29699) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2014-07-02 |