| NPI | 1881656049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: IL 036-117058) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301086836) |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2022-06-28 |