| NPI | 1871629568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A25347) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: CA A25347) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: CA A25347) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: CA A25347) | |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2010-03-10 |