| NPI | 1285161042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ RN163749) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP10181) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2023-10-10 |