| NPI | 1225154545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ RN075687) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AZ AP1932) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2022-11-15 |