| 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 |