| NPI | 1770674269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: DC MD30067) |
| Additional Taxonomies | 2084N0600X (Licence: DC MD30067) |
| 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: DC MD30067) | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2014-09-17 |