| NPI | 1407820509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ AP1515) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: AZ RN091549) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2023-03-07 |