| NPI | 1295275568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: AZ AP10335) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN184359) |
| Enumeration Date | 2017-03-06 |
| Last Update Date | 2018-03-05 |