| NPI | 1124023601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NJ 25MA07233200) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: NJ 25MA07233200) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2012-07-18 |