| NPI | 1063984466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 220431) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: AZ 178074) |
| Enumeration Date | 2018-12-23 |
| Last Update Date | 2022-06-11 |