| NPI | 1174025381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11024487) |
| Additional Taxonomies | 163WX1100X Registered Nurse, Ophthalmic (Licence: FL RN9552643) |
| 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: FL 17-528) | |
| Enumeration Date | 2018-03-03 |
| Last Update Date | 2023-02-23 |