| NPI | 1053301309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NJ 25MA07510800) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MD073184L) |
| 207L00000X Anesthesiology (Licence: NJ 25MA07510800) | |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2014-07-08 |