| NPI | 1467447896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95013876) |
| Additional Taxonomies | 163WP0000X Registered Nurse, Pain Management (Licence: CO APN.0992720-NP) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CO APN.0992720-NP) | |
| 363L00000X Nurse Practitioner (Licence: CO APN.0992720-NP) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: TN APN0000010682) | |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2024-03-12 |