| NPI | 1629280185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084F0202X Psychiatry & Neurology Forensic Psychiatry (Licence: TX D6933) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TX D6933) |
| 2084P2900X Psychiatry & Neurology Pain Medicine (Licence: TX D6933) | |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2007-07-08 |