| NPI | 1275725426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP4059) |
| Additional Taxonomies | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: AZ RN086656) |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2021-08-12 |