| NPI | 1871890525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: CA G45340) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: CA G45340) |
| Enumeration Date | 2011-02-15 |
| Last Update Date | 2024-08-30 |