| NPI | 1952312712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A40769) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: CA 5084) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2011-08-09 |