| NPI | 1285718817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ MA08688500) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NM MD2008-0633) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: NJ MA08688500) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2017-05-10 |