| NPI | 1609106459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: CA 20A12147) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A12147) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA 20A12147) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: CA 20A12147) | |
| Enumeration Date | 2009-12-29 |
| Last Update Date | 2022-10-27 |