| NPI | 1942279054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NY 175401) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 175401) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2010-11-17 |