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 |