| NPI | 1083948723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP8068) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AZ AP8068) |
| 363LF0000X Nurse Practitioner, Family (Licence: NV APN001148) | |
| Enumeration Date | 2009-09-29 |
| Last Update Date | 2021-09-27 |