| NPI | 1003431487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11006659) |
| Additional Taxonomies | 163WS0121X Registered Nurse, Plastic Surgery (Licence: FL RN9460598) |
| Enumeration Date | 2020-06-11 |
| Last Update Date | 2020-11-09 |