| NPI | 1902828569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: CA G71070) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: CA G71070) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2019-12-09 |