NPI | 1508685751 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN318924) |
Additional Taxonomies | 208600000X Surgery (Licence: GA RN318924) |
Enumeration Date | 2024-10-04 |
Last Update Date | 2025-04-28 |