| NPI | 1093488231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: AZ RN192874) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ 262007) |
| Enumeration Date | 2021-07-25 |
| Last Update Date | 2024-07-28 |