| NPI | 1598084782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: FL 9268420) |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other Surgical Technologist (Licence: FL 05173) |
| Enumeration Date | 2010-05-27 |
| Last Update Date | 2019-04-30 |