NPI | 1841430774 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: FL APRN11030303) |
Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other Surgical Assistant (Licence: CO 08194) |
Enumeration Date | 2009-03-05 |
Last Update Date | 2024-01-29 |