| NPI | 1487834560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: CA 20A10191) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A10191) |
| Enumeration Date | 2007-11-06 |
| Last Update Date | 2022-11-21 |