| NPI | 1104453166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MO 2025028099) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IL 036178418) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2026-01-20 |