| NPI | 1356683551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA G62098) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: CA G62098) |
| Enumeration Date | 2013-03-26 |
| Last Update Date | 2017-03-08 |