| NPI | 1790854859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA 230440) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 230440) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: MA 230440) | |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2017-06-15 |