| NPI | 1205148376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS11425) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: FL OS11425) |
| 207Q00000X Family Medicine (Licence: NY 257585) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL OS11425) | |
| Enumeration Date | 2010-07-06 |
| Last Update Date | 2024-05-16 |