| NPI | 1255374062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: NJ 25MA02182900) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 25MA02182900) |
| 207L00000X Anesthesiology (Licence: NJ 25MA02182900) | |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2012-11-26 |