| NPI | 1205403508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 260049) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: AZ RN089048) |
| Enumeration Date | 2021-06-07 |
| Last Update Date | 2022-08-04 |