NPI | 1235660366 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11031696) |
Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: FL 15-566) |
Enumeration Date | 2017-03-21 |
Last Update Date | 2024-08-07 |