| NPI | 1174814933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NY 269588) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 269588) |
| 208VP0000X (Licence: NY 269588) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-04-28 |
| Last Update Date | 2025-07-16 |