| NPI | 1033721071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 297147) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN190607) |
| Enumeration Date | 2020-08-20 |
| Last Update Date | 2026-01-29 |