| NPI | 1548235773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: AZ AP11665) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: AZ RN109444) |
| 163WE0003X Registered Nurse Emergency (Licence: AZ RN109444) | |
| 261QP2300X Clinic/Center Primary Care (Licence: AZ AP11665) | |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2025-08-02 |