| NPI | 1124126776 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NJ 25MA07249000) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: NJ 25MA07249000) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2009-12-03 |