| NPI | 1437871217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11031653) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: WI 17-232) |
| 363L00000X Nurse Practitioner (Licence: FL APRN11031653) | |
| Enumeration Date | 2022-09-19 |
| Last Update Date | 2024-03-07 |