| NPI | 1942558556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: CA A131804) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A131804) |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2016-10-20 |