| NPI | 1194105221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MI 5315244432) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: NC 0010-09447) |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2023-09-21 |