| NPI | 1366609992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: LA MD.205186) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: LA MD.205186) |
| 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: LA MD.205186) | |
| 261QU0200X Clinic/Center, Urgent Care (Licence: LA MD.205186) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2023-06-29 |