| NPI | 1033501937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: IN 71005415A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 71005415A) |
| Enumeration Date | 2015-03-02 |
| Last Update Date | 2019-04-30 |