| NPI | 1689170466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P2900X Psychiatry & Neurology Pain Medicine (Licence: CT 072217) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: CT 072217) |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2024-06-21 |