| NPI | 1124551965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: AZ AP10236) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN170347) |
| Enumeration Date | 2017-04-08 |
| Last Update Date | 2017-08-11 |