| NPI | 1891759254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA C170515) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: UT 149728) |
| 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: UT 149728) | |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2021-05-21 |