| NPI | 1306141213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP5467) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 19900) |
| 363L00000X Nurse Practitioner (Licence: CA 19900) | |
| Enumeration Date | 2011-01-24 |
| Last Update Date | 2019-10-15 |