| NPI | 1396523064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: AZ 301404) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: AZ RN165963) |
| Enumeration Date | 2023-09-15 |
| Last Update Date | 2024-04-19 |