| NPI | 1821037805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NJ 25MA05999500) |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine (Licence: NJ 25MA05999500) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2007-07-08 |