NPI | 1023174042 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA 20A10769) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA OT011347) |
Enumeration Date | 2006-12-28 |
Last Update Date | 2015-06-11 |