| NPI | 1336348432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP1297) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MA RN216869) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 12636) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NM CNP00903) | |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2023-11-09 |