| NPI | 1386810133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: CA A106763) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA A106763) |
| Enumeration Date | 2008-05-01 |
| Last Update Date | 2015-06-07 |