| NPI | 1972676930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: CA G35367) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: CA G35367) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: CA G35367) | |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2011-09-26 |