| NPI | 1457417180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: NJ 25MA04390700) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: NJ 25MA04390700) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2013-03-29 |