| NPI | 1508467374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11025573) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9570547) |
| 163W00000X Registered Nurse (Licence: NY 815105) | |
| 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: FL 17-674) | |
| Enumeration Date | 2020-11-06 |
| Last Update Date | 2023-07-18 |