NPI | 1073918637 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP7374) |
Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care |
Enumeration Date | 2014-10-24 |
Last Update Date | 2023-04-28 |