| NPI | 1366917577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 8984745-4405) |
| Additional Taxonomies | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: UT 8984745-4405) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: UT 8984745-4405) | |
| 363L00000X Nurse Practitioner (Licence: UT 8984745-4405) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: UT 8984745-4405) | |
| Enumeration Date | 2018-10-04 |
| Last Update Date | 2018-10-04 |