| NPI | 1114004587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP3481) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ rn123750) |
| 163WP0000X Registered Nurse, Pain Management (Licence: AZ RN123750) | |
| 363L00000X Nurse Practitioner (Licence: AZ AP3481) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: AZ AP3481) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2023-02-09 |