| NPI | 1043851801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: NC 0010-09573) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2019-10-03 |
| Last Update Date | 2022-04-22 |