| NPI | 1972546364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: MD D0062211) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: MD D0062211) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2020-12-10 |