| NPI | 1205361078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ AP10207) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ RN180193) |
| Enumeration Date | 2017-04-28 |
| Last Update Date | 2022-03-09 |