| NPI | 1174819148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: PA MD461613) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MD461613) |
| 207L00000X Anesthesiology (Licence: NJ 25MA09740800) | |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2018-11-06 |