| NPI | 1043259880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: LA MD.14699R) |
| Additional Taxonomies | 208VP0000X (Licence: NJ MA78363) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2025-11-21 |