| NPI | 1487999488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: UT 6801881-1206) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: UT 6801881-1206) |
| Enumeration Date | 2012-12-01 |
| Last Update Date | 2019-05-16 |