| NPI | 1093189672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: IN 71005986A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 71005986A) |
| Enumeration Date | 2015-11-19 |
| Last Update Date | 2025-01-16 |