| NPI | 1396780409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: PA MD441214) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NY 234995) |
| 207R00000X Internal Medicine (Licence: NY 234995) | |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2021-03-16 |