| NPI | 1740500891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: PA MD454784) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD454784) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 274800) | |
| Enumeration Date | 2010-06-10 |
| Last Update Date | 2017-04-21 |