| NPI | 1235365149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: NY 254761) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 001718) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-06-05 |
| Last Update Date | 2024-04-12 |