| NPI | 1639849193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MI 4704402942) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1049376) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: TX 1049376) | |
| Enumeration Date | 2021-09-16 |
| Last Update Date | 2025-12-15 |