| NPI | 1255879185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP9910) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN160482) |
| Enumeration Date | 2017-02-12 |
| Last Update Date | 2020-12-31 |