| NPI | 1821354200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: CA A128419) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A128419) |
| Enumeration Date | 2012-04-10 |
| Last Update Date | 2024-11-04 |