| NPI | 1538127832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: CA A87957) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA A87957) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2019-04-08 |