| NPI | 1154869063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP10489) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ 171826) |
| Enumeration Date | 2017-02-10 |
| Last Update Date | 2022-12-08 |