| NPI | 1447744735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP11308) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN186001) |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2025-12-13 |