| NPI | 1578119954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: AZ 230221) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: AZ RNP230221) |
| Enumeration Date | 2019-08-12 |
| Last Update Date | 2021-10-04 |