| NPI | 1972097418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: CO DR.0074892) |
| Additional Taxonomies | 2083X0100X Preventive Medicine Occupational Medicine (Licence: CA 20A19690) |
| 2083X0100X Preventive Medicine Occupational Medicine (Licence: CO DR.0074892) | |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2025-08-29 |