| NPI | 1346565280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: CA 20A14068) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: CA 20A14068) |
| 208VP0000X Pain Medicine Pain Medicine (Licence: CA 20A14068) | |
| Enumeration Date | 2010-04-04 |
| Last Update Date | 2023-07-10 |