| NPI | 1124227111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP2069) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NV APN001158) |
| 363LF0000X Nurse Practitioner, Family (Licence: NY F332840-1) | |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2022-01-03 |