| NPI | 1740432848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 9300064) |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: FL HSE9513) |
| Enumeration Date | 2008-10-21 |
| Last Update Date | 2019-12-20 |