| NPI | 1720020571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA G83582) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: WI 55443) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: LA 12374R) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2023-03-07 |