| NPI | 1902033723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: NJ 25MA09857600) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: NJ 25MA09857600) |
| Enumeration Date | 2009-06-19 |
| Last Update Date | 2020-01-08 |