| NPI | 1487660304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NC 36739) |
| Additional Taxonomies | 2084P2900X Psychiatry & Neurology Pain Medicine (Licence: NC 36739) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2007-07-08 |