| NPI | 1699844621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: CA G57474) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G57474) |
| 207R00000X Internal Medicine (Licence: CA G57474) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA G57474) | |
| 2085H0002X Radiology, Hospice and Palliative Medicine (Licence: CA G57474) | |
| 2085R0001X Radiology, Radiation Oncology (Licence: CA G57474) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: CA G57474) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: CA G57474) | |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2018-07-20 |