| NPI | 1306377973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: CA A159125) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A159125) |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2023-11-07 |