| NPI | 1124749155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5016885) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: NC 5016885) |
| 363LF0000X Nurse Practitioner, Family (Licence: NC 5016885) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: NC 5016885) | |
| Enumeration Date | 2022-09-07 |
| Last Update Date | 2024-07-19 |