| NPI | 1043700735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA 164044) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R76840) |
| 208100000X Physical Medicine & Rehabilitation (Licence: CA A164044) | |
| Enumeration Date | 2018-05-17 |
| Last Update Date | 2023-08-16 |