| NPI | 1295453165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 218258) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ F06221757) |
| Enumeration Date | 2022-08-17 |
| Last Update Date | 2022-08-17 |