| NPI | 1275920720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NJ 25MA10858500) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NY 305111) |
| Enumeration Date | 2015-04-22 |
| Last Update Date | 2021-07-16 |