| NPI | 1215576590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA 211862) |
| Additional Taxonomies | 163WX0800X Registered Nurse, Orthopedic (Licence: LA RN132025) |
| Enumeration Date | 2020-01-03 |
| Last Update Date | 2020-02-13 |