| NPI | 1689168486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CT 007616) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CT 12.007616) |
| Enumeration Date | 2018-06-15 |
| Last Update Date | 2022-09-28 |