| NPI | 1477103455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ RNP232092) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN174629) |
| Enumeration Date | 2019-09-12 |
| Last Update Date | 2019-09-12 |