| NPI | 1447606553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX 16-311) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 1130787) |
| Enumeration Date | 2016-05-06 |
| Last Update Date | 2025-12-17 |