| NPI | 1497712483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: NV PA1753) |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine (Licence: PA MA003569L) |
| 363AM0700X Physician Assistant Medical (Licence: PA MA003569L) | |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2020-11-27 |