| NPI | 1285015503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP8200) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704291763) |
| 163WF0300X Registered Nurse, Flight (Licence: AZ RN141174) | |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2022-01-11 |