| NPI | 1639127780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP5296) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: AZ AP5296) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2024-03-01 |