| NPI | 1750318432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA G84131) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA G84131) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA G84131) | |
| 208D00000X General Practice (Licence: CA G84131) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2021-12-23 |