| NPI | 1457630683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: PA MD456000) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MD456000) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: NJ 25MA09852600) | |
| Enumeration Date | 2011-08-05 |
| Last Update Date | 2019-10-23 |