| NPI | 1346501699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: IL 036143270) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IL 036143270) |
| 261QM1300X Clinic/Center Multi-Specialty (Licence: IL 036143270) | |
| Enumeration Date | 2012-06-04 |
| Last Update Date | 2021-10-01 |