| NPI | 1679527543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 102964) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: NC 102964) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2020-09-09 |