| NPI | 1457558595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A9544) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: CA 20A9544) |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: CA 20A9544) | |
| 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: CA 20A9544) | |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2014-04-01 |