| NPI | 1982730701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NJ 25MA08090100) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MD017865E) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: NJ 25MA08090100) | |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2012-05-02 |