| NPI | 1083944052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11001015) |
| Additional Taxonomies | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: FL RNFA9280023) |
| 163WX0800X Registered Nurse, Orthopedic (Licence: IL ONC82798) | |
| Enumeration Date | 2010-01-13 |
| Last Update Date | 2022-02-01 |