| NPI | 1518572668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 237470) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ 237470) |
| Enumeration Date | 2020-09-14 |
| Last Update Date | 2023-12-18 |