| NPI | 1770772071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: CA G59473) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G59473) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: CA G59473) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: CA G59473) | |
| Enumeration Date | 2007-10-23 |
| Last Update Date | 2010-07-22 |