| NPI | 1902252810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: IL 036152484) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: IL 036.152484) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: AR 921781266) | |
| Enumeration Date | 2016-05-10 |
| Last Update Date | 2024-02-12 |