| NPI | 1639292758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: CA 20A9973) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MA 231672) |
| 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A9973) | |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: CA 20A9973) | |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2025-08-17 |