| NPI | 1689900334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: FL 11018509) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other Surgical Assistant |
| Enumeration Date | 2009-10-29 |
| Last Update Date | 2024-06-03 |