| NPI | 1396759197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD00046532) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D0060488) |
| 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: WA MD00046532) | |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2018-05-16 |