| NPI | 1104328160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9365764) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: FL ARNP9365764) |
| Enumeration Date | 2018-03-06 |
| Last Update Date | 2018-03-06 |