| NPI | 1194163865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP5215) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ 133659) |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2013-10-01 |