| NPI | 1548704125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP9767) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ 068839) |
| Enumeration Date | 2016-12-15 |
| Last Update Date | 2021-03-22 |