| NPI | 1447632468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ AP7949) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN171003) |
| Enumeration Date | 2015-06-25 |
| Last Update Date | 2015-08-06 |