| NPI | 1134323553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: HI APRN2335) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN090498) |
| 363LF0000X Nurse Practitioner, Family (Licence: AZ AP2869) | |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2020-06-09 |