| NPI | 1073500013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: NY 194152) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 194152) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NY 194152) | |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2022-08-12 |