| NPI | 1679764187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NY 200 742) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 200742) |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2019-02-05 |