| NPI | 1013072537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA A64040) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA A64040) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: CA A64040) | |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2023-09-05 |