NPI | 1447825534 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MT NUR-APRN-LIC-240601) |
Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: MT NUR-APRN-LIC-240601) |
Enumeration Date | 2021-05-21 |
Last Update Date | 2024-09-26 |