| NPI | 1811928369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 207890) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NY 207890) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: NY 207890) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2019-03-11 |