| NPI | 1407891658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: CA C138763) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD426970) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 239973) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA C138763) | |
| 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: NH AM0443173-6259) | |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2022-07-21 |