| NPI | 1396354734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5013380) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: NC 5013380) |
| 363LF0000X Nurse Practitioner, Family (Licence: NC 5013380) | |
| Enumeration Date | 2020-07-30 |
| Last Update Date | 2023-05-02 |