| NPI | 1114405503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ AP11596) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AZ AP11596) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: AZ AP11596) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: AZ AP11596) | |
| Enumeration Date | 2018-07-30 |
| Last Update Date | 2020-10-01 |