| NPI | 1730687476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: NC 5010209) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC 5010209) |
| Enumeration Date | 2018-01-29 |
| Last Update Date | 2021-12-09 |