| NPI | 1639717713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS 903338) |
| Additional Taxonomies | 163WC1600X Registered Nurse, Continuing Education/Staff Development (Licence: MS 903338) |
| 163WH1000X Registered Nurse, Hospice (Licence: MS 903338) | |
| 163WI0500X Registered Nurse, Infusion Therapy (Licence: MS 903338) | |
| 163WN1003X Registered Nurse, Nutrition Support (Licence: MS 903338) | |
| 163WW0000X Registered Nurse, Wound Care (Licence: MS 903338) | |
| 163WX0200X Registered Nurse, Oncology (Licence: MS 903338) | |
| 207X00000X Orthopaedic Surgery (Licence: MS 903338) | |
| 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: MS 903338) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MS 903338) | |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: MS 903338) | |
| Enumeration Date | 2019-12-19 |
| Last Update Date | 2019-12-19 |