| NPI | 1609124072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL OS17196) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IL 125.060829) |
| 208100000X Physical Medicine & Rehabilitation (Licence: IL 036133901) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MN 61131) | |
| Enumeration Date | 2012-08-16 |
| Last Update Date | 2023-11-17 |