| NPI | 1558527382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: CT 64272) |
| Additional Taxonomies | 2084P2900X Psychiatry & Neurology Pain Medicine (Licence: NY 231619) |
| Enumeration Date | 2008-07-31 |
| Last Update Date | 2021-02-25 |