| NPI | 1972811628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NY 317252-01) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 011927) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-09-15 |
| Last Update Date | 2022-06-07 |