| NPI | 1770715575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA A110631) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: CA A110631) |
| Enumeration Date | 2009-08-13 |
| Last Update Date | 2020-03-24 |