| NPI | 1790840049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: CA A25386) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA A25386) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA A25386) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2024-04-30 |