| NPI | 1750366290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: FL ME54040) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: FL ME54040) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2020-11-30 |