| NPI | 1316055700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: NC 101104) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 101104) |
| Enumeration Date | 2006-08-27 |
| Last Update Date | 2023-08-21 |