| NPI | 1174516157 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: NJ 25MA06614900) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: NJ 25MA06614900) |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2011-10-06 |