| NPI | 1821026147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: IL 036.118972) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IL 036.118972) |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: IL 036.118972) | |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2010-12-29 |