| NPI | 1528555216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: IN 71007920A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 28207276A) |
| 363LF0000X Nurse Practitioner, Family (Licence: IN 28207276A) | |
| Enumeration Date | 2018-04-18 |
| Last Update Date | 2025-01-14 |