| NPI | 1710002696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX P3036) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: TX P3036) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: TX P3036) | |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: TX P3036) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX P3036) | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2020-06-26 |