| NPI | 1568140614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 10804) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: IA H174968) |
| Enumeration Date | 2023-07-10 |
| Last Update Date | 2023-10-18 |