| NPI | 1972999753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: CA C200426) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MD D89189) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MD D0089189) | |
| Enumeration Date | 2015-04-08 |
| Last Update Date | 2025-08-01 |