| NPI | 1720396138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: NJ 25MA09751000) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 57 . 017406) |
| Enumeration Date | 2010-09-20 |
| Last Update Date | 2020-12-07 |