| NPI | 1386962686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA 20A12157) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: CA 20A12157) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: CA 20A12157) | |
| Enumeration Date | 2010-05-11 |
| Last Update Date | 2017-02-22 |