| NPI | 1255301164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: PR 01819) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NJ 25MA06787000) |
| 207LC0200X Anesthesiology Critical Care Medicine (Licence: PR 018019) | |
| 207LP2900X Anesthesiology Pain Medicine (Licence: PR 18019) | |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: NJ 25MA067870) | |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2020-12-30 |