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 |