| NPI | 1336108372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: CA A83645) |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine (Licence: CA A83645) |
| Enumeration Date | 2006-03-20 |
| Last Update Date | 2007-07-08 |