NPI | 1376510396 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA G55642) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA G55642) |
Enumeration Date | 2006-03-08 |
Last Update Date | 2019-04-03 |