NPI | 1215380969 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ RN171460) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP9557) |
Enumeration Date | 2016-07-18 |
Last Update Date | 2021-08-31 |