{
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"FirstLineMailingAddress": "8706 HILLCREST CIR",
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"FirstLinePracticeLocationAddress": "11832 ROSECRANS AVE",
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"EnumerationDate": "04/26/2007",
"LastUpdateDate": "03/07/2023",
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"NPIReactivationDate": null,
"GenderCode": "M",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Pain Medicine Physician",
"LicenseNumber": "C62909B",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
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}
}