| NPI | 1831590439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: CA A133500) |
| Additional Taxonomies | 2084S0010X Psychiatry & Neurology, Sports Medicine (Licence: CA A133500) |
| Enumeration Date | 2014-09-15 |
| Last Update Date | 2021-10-18 |