| NPI | 1851694889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: MA 273617) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 274620) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 2018-01283) | |
| Enumeration Date | 2010-12-14 |
| Last Update Date | 2023-07-24 |