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 |