| NPI | 1518256767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P2900X Psychiatry & Neurology Pain Medicine (Licence: NY 202189) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: NY 202189) |
| 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: NY 202189) | |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: NY 202189) | |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: NY 202189) | |
| Enumeration Date | 2011-03-28 |
| Last Update Date | 2018-06-06 |