| NPI | 1639309685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX Q0355) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: TX Q0355) |
| Enumeration Date | 2009-07-23 |
| Last Update Date | 2022-06-24 |