| NPI | 1821456716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95003616) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: CA 741448) |
| Enumeration Date | 2016-02-05 |
| Last Update Date | 2025-02-03 |