| NPI | 1477831196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: LA AP06636) |
| Additional Taxonomies | 163WX0800X Registered Nurse, Orthopedic (Licence: LA RN114345) |
| Enumeration Date | 2011-07-29 |
| Last Update Date | 2021-09-13 |