| NPI | 1619947801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME114651) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AZ 23903) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: FL ME114651) | |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2022-07-21 |