| NPI | 1295120202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: NY 316384) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25M10908100) |
| 208000000X Pediatrics (Licence: ND PT15121) | |
| 208000000X Pediatrics (Licence: NY 316384) | |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2023-07-18 |