| NPI | 1811563125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: VA 0116042416) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 320769) |
| Enumeration Date | 2021-05-28 |
| Last Update Date | 2026-07-09 |