| NPI | 1962423400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: HI MD12904) |
| Additional Taxonomies | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: HI MD12904) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2007-07-08 |