NPI | 1982080099 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: FL APRN11006151) |
Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other Surgical Assistant (Licence: CO 13-573) |
Enumeration Date | 2015-07-31 |
Last Update Date | 2020-02-26 |