NPI | 1013286335 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA168476) |
Additional Taxonomies | 208VP0000X (Licence: OR PA168476) |
208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: OR PA168476) | |
Enumeration Date | 2011-12-14 |
Last Update Date | 2025-05-21 |