NPI | 1740262146 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11014730) |
Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other Surgical Technologist |
363LF0000X Nurse Practitioner Family (Licence: FL APRN11014730) | |
Enumeration Date | 2005-11-19 |
Last Update Date | 2021-09-01 |