| NPI | 1104375732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 259986) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN082944) |
| Enumeration Date | 2016-09-23 |
| Last Update Date | 2024-05-30 |