| NPI | 1013632843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ RNP287368) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ RN177541) |
| Enumeration Date | 2022-10-04 |
| Last Update Date | 2023-02-09 |