| NPI | 1740438043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA A107331) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NJ 25MA08475400) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: NJ 25MA08475400) | |
| Enumeration Date | 2008-08-29 |
| Last Update Date | 2011-11-29 |