| NPI | 1396500492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ 285233) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ CNP285233) |
| Enumeration Date | 2024-02-19 |
| Last Update Date | 2024-10-16 |