| NPI | 1912181389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.097615) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: DC MD036595) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 097615) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: OH 35.097615) | |
| Enumeration Date | 2007-12-20 |
| Last Update Date | 2012-01-28 |