| NPI | 1184247116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: FL F11230010) |
| Additional Taxonomies | 163WX0800X Registered Nurse Orthopedic (Licence: FL RN9521938) |
| Enumeration Date | 2020-05-26 |
| Last Update Date | 2024-09-24 |