| NPI | 1336726447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ 261707) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ 192810) |
| 163W00000X Registered Nurse (Licence: AZ 261707) | |
| 363LF0000X Nurse Practitioner, Family (Licence: AZ 261707) | |
| Enumeration Date | 2021-03-25 |
| Last Update Date | 2021-09-15 |