| NPI | 1518993120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: VA 0102201991) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102201991) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: VA 0102201991) | |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2024-06-07 |