| NPI | 1790809960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: IL 036088691) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IL 036088691) |
| 207R00000X Internal Medicine (Licence: IL 036088691) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: IL 036088691) | |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2007-07-24 |