| NPI | 1790930113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: NY 263062) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 263062) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: NY 263062) | |
| Enumeration Date | 2008-11-26 |
| Last Update Date | 2024-03-21 |