| NPI | 1811193949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11003868) |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: FL 05-179) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2019-08-26 |