| NPI | 1417218595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 328243) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO 186628) |
| Enumeration Date | 2012-06-05 |
| Last Update Date | 2025-08-15 |