| NPI | 1972575801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: CT 045712) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 237889) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: CT 045712) | |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2011-03-29 |