| NPI | 1063708568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: NY 325866) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 325866) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NY 325866) | |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2024-03-15 |