| NPI | 1275512931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO 37051) |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine (Licence: CO 37051) |
| 208100000X Physical Medicine & Rehabilitation (Licence: IL 036097759) | |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2021-10-27 |