| NPI | 1225482821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA 169225) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA 169225) |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2021-09-05 |