| NPI | 1225001118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ AP6056) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AZ RN067055) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2019-09-09 |