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 |