| NPI | 1184853152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: MO 2015028059) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: IL 036.133727) |
| Enumeration Date | 2009-07-10 |
| Last Update Date | 2023-04-05 |