| NPI | 1164144077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 296590) |
| Additional Taxonomies | 163WP2201X Registered Nurse, Ambulatory Care (Licence: AZ 214795) |
| Enumeration Date | 2022-09-16 |
| Last Update Date | 2024-04-18 |