| NPI | 1386088649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP4898) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AZ AP4898) |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2023-12-08 |