| NPI | 1184277139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: AZ 233029) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AZ 233029) |
| 363LC1500X Nurse Practitioner Community Health (Licence: AZ 233029) | |
| 363LP2300X Nurse Practitioner Primary Care (Licence: AZ 233029) | |
| Enumeration Date | 2019-07-18 |
| Last Update Date | 2023-03-23 |