| NPI | 1629188503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME135211) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: NY 200861) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: NJ 25MA06674900) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2019-02-27 |