| NPI | 1245907666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NH 1793) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: NH pending) |
| Enumeration Date | 2021-08-24 |
| Last Update Date | 2021-10-12 |