| NPI | 1871895375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NY 257111) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 257111-1) |
| Enumeration Date | 2010-12-03 |
| Last Update Date | 2019-03-15 |