| NPI | 1023202355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NY P60524) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 248830) |
| Enumeration Date | 2007-08-29 |
| Last Update Date | 2019-10-16 |