| NPI | 1164419073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: CA A89459) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CA A89459) |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2011-09-19 |