| NPI | 1114364049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP4987) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: AZ AP4987) |
| Enumeration Date | 2013-06-02 |
| Last Update Date | 2024-10-07 |