| NPI | 1225435514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP11212) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN139438) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ AP11212) | |
| Enumeration Date | 2014-12-02 |
| Last Update Date | 2020-10-12 |