| NPI | 1265762983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A-40775) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A-40775) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: CA A-40775) | |
| Enumeration Date | 2009-12-31 |
| Last Update Date | 2009-12-31 |