| NPI | 1013297845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: NY 307255) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 307255) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: NY 307255) | |
| 363AM0700X Physician Assistant, Medical (Licence: NY 014673) | |
| Enumeration Date | 2011-08-24 |
| Last Update Date | 2023-06-22 |