| NPI | 1932460078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: FL APRN9471296) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R187459) |
| 363LF0000X Nurse Practitioner, Family (Licence: NY 337484) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NC 5009092) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9471296) | |
| Enumeration Date | 2012-06-05 |
| Last Update Date | 2023-09-12 |