| NPI | 1700808003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD035260E) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ 25MA11176600) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME78289) | |
| 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: NJ 25MA11176600) | |
| 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: PA MD035260E) | |
| 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: FL ME78289) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2022-08-23 |