| NPI | 1205912987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP2003) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: AZ RN093072) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2016-08-25 |