| NPI | 1275221285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: MD R200261) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MD R200261) |
| Enumeration Date | 2023-04-27 |
| Last Update Date | 2024-06-01 |