| NPI | 1194065730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: ID NP-1275A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 774657) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 21853) | |
| 363LF0000X Nurse Practitioner, Family (Licence: ID NP-1275A) | |
| Enumeration Date | 2013-02-19 |
| Last Update Date | 2024-09-10 |