| NPI | 1477072130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ AP10673) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: AZ AP10673) |
| 363LF0000X Nurse Practitioner, Family (Licence: AZ AP10673) | |
| Enumeration Date | 2017-09-14 |
| Last Update Date | 2018-03-17 |