| NPI | 1710944293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: UT 1573651205) |
| Additional Taxonomies | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: WY 6062A) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2021-11-15 |