| NPI | 1609093319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A60010) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: CA A60010) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2012-06-20 |