| NPI | 1962824151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 8686213-1206) |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine (Licence: UT 8686213-1206) |
| 363AM0700X Physician Assistant Medical | |
| Enumeration Date | 2014-01-08 |
| Last Update Date | 2024-04-08 |