| NPI | 1578047973 |
|---|---|
| Former Name | SAME AS ABOVE SAME AS ABOVE SAME AS ABOVE |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD R201094) |
| Additional Taxonomies | 163WP0000X Registered Nurse, Pain Management (Licence: MD R201094) |
| Enumeration Date | 2018-09-20 |
| Last Update Date | 2024-01-03 |