| NPI | 1851353502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NY 28074501) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OR md28743) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: OR MD28743) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: OR MD28743) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: OR MD28743) | |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2024-06-07 |