| NPI | 1972828457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NC 5006588) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: IN 71003291A) |
| 363LF0000X Nurse Practitioner Family (Licence: IN F1109060) | |
| 208VP0000X Pain Medicine Pain Medicine (Licence: NC 5006588) | |
| 363LP2300X Nurse Practitioner Primary Care (Licence: NC 5006588) | |
| Enumeration Date | 2010-03-29 |
| Last Update Date | 2020-06-25 |