| NPI | 1104353929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP10534) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ RN176481) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2020-09-15 |