| NPI | 1285697144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: FL ME0054890) |
| Additional Taxonomies | 261QP3300X Clinic/Center, Pain (Licence: IL 036.133524) |
| 261QP3300X Clinic/Center, Pain (Licence: NJ 25MA09257000) | |
| 261QP3300X Clinic/Center, Pain (Licence: NV 14695) | |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2022-07-21 |