| 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 |