| 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 |