| NPI | 1558774729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL ME162890) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 289017) |
| 207P00000X Emergency Medicine (Licence: FL ME162890) | |
| 207P00000X Emergency Medicine (Licence: TX W1917) | |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2026-09-30 |