NPI | 1235304205 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: NC 101656) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 101656) |
Enumeration Date | 2008-04-29 |
Last Update Date | 2021-12-14 |