| NPI | 1326660457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 276070) |
| Additional Taxonomies | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: AZ RN119607) |
| Enumeration Date | 2020-05-12 |
| Last Update Date | 2025-10-13 |