| NPI | 1508814807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: TX MDG9190) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: DC MD039126) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2024-09-07 |