| NPI | 1275846552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: CA G15640) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: CA G15640) |
| Enumeration Date | 2010-07-15 |
| Last Update Date | 2013-10-08 |