| NPI | 1861906612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 2895) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: SC 2895) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2017-11-30 |
| Last Update Date | 2024-09-24 |