| NPI | 1114023058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: CA A81550) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A81550) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2022-12-07 |