| NPI | 1821013962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: CA A88814) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CA A88814) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2019-09-27 |