| NPI | 1659418119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: KY 41448) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: KY 41448) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2009-09-10 |