| NPI | 1619997624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A4926) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: CA 2OA4926) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2021-12-03 |