| NPI | 1992212740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: FL ARPN11024769) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other Surgical Assistant (Licence: FL 17-686) |
| Enumeration Date | 2018-01-02 |
| Last Update Date | 2023-03-11 |