| NPI | 1578118659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 8508793-4405) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: UT 8508793-4405) |
| Enumeration Date | 2019-08-06 |
| Last Update Date | 2022-02-10 |