| NPI | 1124341060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: CA #G39528) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: CA G39528) |
| Enumeration Date | 2010-03-07 |
| Last Update Date | 2010-03-07 |