| NPI | 1700860822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: FL ME110173) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: MS 19091) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: CA A12287) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: NJ 25MA08875800) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: ZZ Master Degree) | |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2015-05-06 |