| NPI | 1164496444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ RN084673) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AZ 370) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2010-02-24 |