| NPI | 1255596060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP3053) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AZ AP3053) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: AZ AP3053) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: AZ AP3053) | |
| Enumeration Date | 2008-07-21 |
| Last Update Date | 2023-03-21 |