| NPI | 1407855315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AK 203883) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: KY 27953) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: KY 27953) | |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2023-10-11 |