| NPI | 1790700912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: NY 168981-1) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 168981) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2021-02-24 |