| NPI | 1851509277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: IN 28112325A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704232837) |
| 163WP0000X Registered Nurse, Pain Management (Licence: IL 041173347) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2007-07-08 |