| NPI | 1558602227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: AZ AP10216) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 306400) |
| Enumeration Date | 2013-03-06 |
| Last Update Date | 2018-03-17 |