| NPI | 1285054312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 18736) |
| Additional Taxonomies | 163WX0800X Registered Nurse Orthopedic (Licence: TN 202421) |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2023-04-05 |