| NPI | 1710972674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NY 224755-1) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 224755-1) |
| Enumeration Date | 2005-09-16 |
| Last Update Date | 2022-05-19 |