| NPI | 1366758922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: PR 1810) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NY 300961) |
| Enumeration Date | 2010-08-20 |
| Last Update Date | 2022-09-07 |