| NPI | 1275591612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP0366) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ APO0366) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2023-01-25 |