| NPI | 1073917829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: AZ AP7427) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: UT 5811750) |
| Enumeration Date | 2014-10-22 |
| Last Update Date | 2025-08-14 |