| NPI | 1356371884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA 20A12928) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 239449-1) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2021-08-15 |