| NPI | 1427569110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP10723) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN174745) |
| Enumeration Date | 2017-10-20 |
| Last Update Date | 2020-07-30 |