| NPI | 1922180520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: CT 1.043980) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: NY 256799) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2024-09-09 |