| NPI | 1790394641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.006846RX) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: IN 10003443A) |
| 363A00000X Physician Assistant (Licence: IN 10003443A) | |
| Enumeration Date | 2020-07-27 |
| Last Update Date | 2024-09-23 |