| NPI | 1750450888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: NY 126493) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 126493) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2021-08-25 |