| NPI | 1376076042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: CT 73423) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 310564) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-09 |
| Last Update Date | 2023-07-07 |