| NPI | 1629068713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: MA 207879) |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine (Licence: MA 207879) |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2007-07-08 |