| NPI | 1427413913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP10585) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95019137) |
| Enumeration Date | 2015-12-28 |
| Last Update Date | 2023-06-06 |