| NPI | 1235905662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: AZ 246936) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ 246936) |
| Enumeration Date | 2023-11-27 |
| Last Update Date | 2023-11-27 |