| NPI | 1619165867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: PA MD439665) |
| Additional Taxonomies | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: NJ 25MA08897600) |
| Enumeration Date | 2007-10-11 |
| Last Update Date | 2020-09-29 |