| NPI | 1457707333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: MA 287570) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: MA 287570) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 287570) | |
| Enumeration Date | 2016-05-10 |
| Last Update Date | 2024-04-22 |