NPI | 1023578895 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11002128) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL APRN11002128) |
208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL APRN11002128) | |
363L00000X Nurse Practitioner (Licence: PA SP020029) | |
Enumeration Date | 2019-03-20 |
Last Update Date | 2022-08-24 |