| NPI | 1891191672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: OR 201407551np-pp) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OR 201407551NP-PP) |
| Enumeration Date | 2014-11-06 |
| Last Update Date | 2024-03-28 |