| NPI | 1063890853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: FL ME155130) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: NJ 25MA10601200) |
| 207L00000X Anesthesiology (Licence: NJ 25MA10601200) | |
| Enumeration Date | 2015-05-12 |
| Last Update Date | 2025-09-30 |