| NPI | 1205489804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-140866) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: AL 1-140866) |
| Enumeration Date | 2019-07-23 |
| Last Update Date | 2022-07-14 |