| NPI | 1467497370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 201608786NP-PP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN120573) |
| 363LF0000X Nurse Practitioner, Family (Licence: AZ AP1656) | |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2022-07-22 |