| NPI | 1861447955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MA 245337) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NY 217196) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: MA 245337) | |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2012-09-19 |