| NPI | 1063754455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11020794) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: FL ABSA 12-191) |
| 163W00000X Registered Nurse (Licence: FL RN9544171) | |
| Enumeration Date | 2013-03-23 |
| Last Update Date | 2023-01-30 |