| NPI | 1306964002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A5845) |
| Additional Taxonomies | 2083S0010X Preventive Medicine Sports Medicine (Licence: CA 20A5845) |
| 2083X0100X Preventive Medicine Occupational Medicine (Licence: CA 20A5845) | |
| 208D00000X General Practice (Licence: CA 20A5845) | |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: CA 20A5845) | |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2007-07-08 |