| NPI | 1659397917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA C52562) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101225204) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2021-12-09 |