| NPI | 1104176627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: AZ AP8379) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: AZ TAP8379) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 5005741) | |
| Enumeration Date | 2012-09-12 |
| Last Update Date | 2024-02-20 |