| NPI | 1356643043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA 20A3768) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: MI 5101006652) |
| Enumeration Date | 2010-12-01 |
| Last Update Date | 2019-01-03 |