| NPI | 1497339220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 272897) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN183690) |
| Enumeration Date | 2021-05-07 |
| Last Update Date | 2022-03-24 |