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 |