| NPI | 1164045167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA 20A24053) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: CA 20A24053) |
| Enumeration Date | 2020-05-26 |
| Last Update Date | 2025-10-22 |