| NPI | 1760572903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: NY 221956) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 221956) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2016-02-22 |