| NPI | 1689025504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: PA OS020669) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NJ 25MB10735400) |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2024-06-28 |