| NPI | 1326477134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP7356) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN172210) |
| Enumeration Date | 2013-11-02 |
| Last Update Date | 2015-07-16 |