| NPI | 1144759341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP10192) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ TAP10192) |
| Enumeration Date | 2017-06-09 |
| Last Update Date | 2022-07-21 |