| NPI | 1609221787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX T1805) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IL 036-152625) |
| Enumeration Date | 2016-04-26 |
| Last Update Date | 2025-11-26 |