| NPI | 1134117211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NY 224928) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 224928) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2015-02-16 |