| 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 | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: MD R201094) |
| 163WP0000X Registered Nurse Pain Management (Licence: MD R201094) | |
| Enumeration Date | 2018-09-20 |
| Last Update Date | 2024-09-18 |