| NPI | 1184838328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ TAP2629) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY 335840) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2024-06-20 |