| NPI | 1033129150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP4826) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ TAP4826) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2019-11-21 |