| NPI | 1386993814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A130398) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 52112) |
| 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: MO 2015038281) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MO 2015038281) | |
| Enumeration Date | 2012-08-30 |
| Last Update Date | 2024-12-12 |