| NPI | 1407246689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ AP7436) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ MSL230690NC) |
| 163W00000X Registered Nurse (Licence: NC 230690) | |
| Enumeration Date | 2015-01-27 |
| Last Update Date | 2015-02-02 |