| NPI | 1013630417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: PA SP02162) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: PA SP02162) |
| Enumeration Date | 2022-09-21 |
| Last Update Date | 2023-04-03 |