| NPI | 1265903116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 220281) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ F12180436) |
| Enumeration Date | 2018-12-17 |
| Last Update Date | 2021-07-06 |