| NPI | 1659502870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NJ MA38715) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NJ MA38715) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: NJ MA38715) | |
| Enumeration Date | 2009-08-05 |
| Last Update Date | 2011-04-08 |