| NPI | 1578508685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: NY 200116) |
| Additional Taxonomies | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: NJ 25MA06439900) |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2015-04-23 |