| NPI | 1679559421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA 20A6596) |
| Additional Taxonomies | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: CA 20a6596) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2013-11-07 |