| NPI | 1245876499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: AZ 235030) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: AZ RN185478) |
| Enumeration Date | 2019-11-22 |
| Last Update Date | 2020-01-22 |