| NPI | 1407228216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 7760523-1206) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: UT 7760523-1206) |
| Enumeration Date | 2015-10-21 |
| Last Update Date | 2023-11-28 |