| NPI | 1558033969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ 276425) |
| Additional Taxonomies | 163WG0000X Registered Nurse General Practice (Licence: AZ RN196045) |
| 207R00000X Internal Medicine (Licence: AZ 276425) | |
| Enumeration Date | 2021-10-04 |
| Last Update Date | 2022-11-27 |