| NPI | 1437444106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ 278333) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 376954) |
| Enumeration Date | 2011-06-10 |
| Last Update Date | 2022-08-16 |