| NPI | 1548246101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P2900X Psychiatry & Neurology Pain Medicine (Licence: WI 49603-20) |
| Additional Taxonomies | 2084P2900X Psychiatry & Neurology Pain Medicine (Licence: CA A082703) |
| 2084P2900X Psychiatry & Neurology Pain Medicine (Licence: WI 49603) | |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2013-08-14 |