| NPI | 1811159973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: TX P3848) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX P3848) |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: IL 036133236) | |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2022-07-21 |