| NPI | 1861887291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: IL 036.147936) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IL 036.147936) |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2026-07-24 |