| NPI | 1386962785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: NJ 25MB08757700) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NJ 25MB08757700) |
| Enumeration Date | 2010-05-10 |
| Last Update Date | 2018-05-02 |