| NPI | 1710307731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: NY 298411) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 260802) |
| Enumeration Date | 2014-04-17 |
| Last Update Date | 2020-01-14 |