| NPI | 1871975672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: MN 75058) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX BP10052508) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2020005835) | |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2024-02-16 |