| NPI | 1447757018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: NY 322019) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: MN 74475) |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: MD H0094037) | |
| Enumeration Date | 2018-04-10 |
| Last Update Date | 2023-10-10 |