| NPI | 1427507680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: AZ AP9542) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: AZ RN180149) |
| Enumeration Date | 2016-09-29 |
| Last Update Date | 2020-09-02 |