| NPI | 1568401024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 252468) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CT 044176) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: CT 044176) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: CT 044176) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: NY 252468) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NY 252468) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2013-12-12 |