| NPI | 1326012154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA G69750) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA g69750) |
| Enumeration Date | 2006-02-16 |
| Last Update Date | 2011-12-29 |