| NPI | 1427680131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: AZ RN128111) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ 239907) |
| Enumeration Date | 2020-02-10 |
| Last Update Date | 2020-06-23 |