| NPI | 1033614367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: AZ AP10616) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: AZ AP10616) |
| 207R00000X Internal Medicine (Licence: AZ AP10616) | |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2018-05-31 |