| NPI | 1962421198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: NY 234695) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 234695) |
| 207LA0401X Anesthesiology, Addiction Medicine (Licence: NY 234695) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: NY 234695) | |
| 208D00000X General Practice (Licence: NY 234695) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2016-01-28 |