| NPI | 1447739859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CT 7670) |
| Additional Taxonomies | 208600000X Surgery (Licence: CT 7670) |
| Enumeration Date | 2018-08-08 |
| Last Update Date | 2021-12-21 |