| NPI | 1780605618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 173000000X Legal Medicine (Licence: MO ACFE-380) |
| Additional Taxonomies | 174400000X Specialist (Licence: NV 01474-L) |
| 175F00000X Naturopath (Licence: DC NAT0047) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: CA 1123) | |
| Enumeration Date | 2006-07-23 |
| Last Update Date | 2018-04-27 |