| NPI | 1306817424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: NM CNP-02649) |
| Additional Taxonomies | 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: TX 679613) |
| 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: CA 691807) | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: TX 679613) | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: CA 20944) | |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2024-11-19 |