| NPI | 1447880299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 234960) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ TEMP234960) |
| Enumeration Date | 2020-01-21 |
| Last Update Date | 2023-10-09 |