NPI | 1609387083 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: WA AP607873) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4707263457) |
363LA2200X Nurse Practitioner, Adult Health (Licence: MI 4707263457) | |
Enumeration Date | 2017-10-12 |
Last Update Date | 2019-05-16 |