| NPI | 1750613279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11010321) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other Surgical Assistant (Licence: FL 09177) |
| Enumeration Date | 2010-02-09 |
| Last Update Date | 2021-09-08 |