| NPI | 1316105182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: LA MD 201074) |
| Additional Taxonomies | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: LA MD 201074) |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2017-09-14 |