| NPI | 1285979716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1032435) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX 12-221) |
| 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: TX 12-221) | |
| Enumeration Date | 2012-12-10 |
| Last Update Date | 2024-04-13 |