| NPI | 1710519665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL F01201439) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL APRN11006106) |
| Enumeration Date | 2020-02-09 |
| Last Update Date | 2026-01-05 |