| NPI | 1306503396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ 271415) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN197310) |
| Enumeration Date | 2021-11-24 |
| Last Update Date | 2024-03-22 |