| NPI | 1053744524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: OR PA164650) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: OR PA164650) |
| 363A00000X Physician Assistant (Licence: OR PA164650) | |
| Enumeration Date | 2013-08-19 |
| Last Update Date | 2024-04-22 |