| NPI | 1104822857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NJ 25MA08301300) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MD-042377-L) |
| 208VP0000X Pain Medicine Pain Medicine (Licence: PA MD042377L) | |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2023-01-06 |