| NPI | 1699174995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11024689) |
| Additional Taxonomies | 104100000X Social Worker |
| 246ZC0007X Specialist/Technologist, Other, Surgical Assistant | |
| Enumeration Date | 2014-08-22 |
| Last Update Date | 2023-02-27 |