| NPI | 1164415733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: NJ 25MA06250900) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: NJ 25MA06250900) |
| Enumeration Date | 2005-08-29 |
| Last Update Date | 2011-10-06 |