| NPI | 1174182760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 230322) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN149517) |
| Enumeration Date | 2019-06-07 |
| Last Update Date | 2024-04-23 |