| NPI | 1902804438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: NJ 25MA04542600) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ MA45426) |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2013-08-07 |