| NPI | 1487610713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: NC 28819) |
| Additional Taxonomies | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: NC 28819) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 28819) | |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2022-04-22 |