| NPI | 1982608592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: NY 209422-1) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NY 209422-1) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: TN 42862) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TN 42862) | |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2018-07-03 |