| NPI | 1760496574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA A104152) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CA A104152) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2015-02-10 |