| NPI | 1700248721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: CA A173034) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA A173034) |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2022-07-21 |