| NPI | 1447800164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL F09231243) |
| Additional Taxonomies | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: FL RN-9529942) |
| 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: AZ 16-743) | |
| Enumeration Date | 2019-09-14 |
| Last Update Date | 2023-10-01 |