| NPI | 1275845133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA A133899) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD449485) |
| Enumeration Date | 2010-07-08 |
| Last Update Date | 2024-05-07 |