| NPI | 1528457827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX 1022089) |
| Additional Taxonomies | 163WG0000X Registered Nurse General Practice (Licence: NY 787482) |
| 246ZC0007X Specialist/Technologist, Other Surgical Assistant | |
| 163WA2000X Registered Nurse Administrator (Licence: TX 1022089) | |
| Enumeration Date | 2015-01-10 |
| Last Update Date | 2023-03-14 |