| NPI | 1306054150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081H0002X (Licence: CA A97825) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA A97825) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2012-11-01 |