| NPI | 1346773520 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA 20A22931) | 
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX T1637) | 
| Enumeration Date | 2017-04-05 | 
| Last Update Date | 2025-09-12 |