| NPI | 1871616995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: MI 4301029747) |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine (Licence: MI 4301029747) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2009-08-20 |