| NPI | 1932369675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: CA a67793) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: CA A67793) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: CA A67793) | |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2021-08-03 |