| NPI | 1902825177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: NY 203923) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 203923) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2019-07-29 |