| NPI | 1063705259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: IL 036.138472) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IL 036138472) |
| 207L00000X Anesthesiology (Licence: MA 258353) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: IL 036.138472) | |
| Enumeration Date | 2011-05-19 |
| Last Update Date | 2021-03-15 |