| NPI | 1770691123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX M9502) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 234619) |
| Enumeration Date | 2006-08-27 |
| Last Update Date | 2022-03-02 |