| NPI | 1457860751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: AZ AP11101) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN186860) |
| Enumeration Date | 2017-09-29 |
| Last Update Date | 2021-03-10 |