| NPI | 1497211999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11017780) |
| Additional Taxonomies | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: FL 110117780) |
| 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: WI 16-508) | |
| Enumeration Date | 2019-02-20 |
| Last Update Date | 2022-03-04 |