| NPI | 1831191956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A74120) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: CA A74120) |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: CA A74120) | |
| 208D00000X General Practice (Licence: CA A74120) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: CA A74120) | |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2021-07-08 |