| NPI | 1699512673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: LA 205628) |
| Additional Taxonomies | 163WX0800X Registered Nurse Orthopedic (Licence: LA 205628) |
| Enumeration Date | 2024-07-09 |
| Last Update Date | 2024-09-03 |