| NPI | 1578871026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ AP3788) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AZ RN113582) |
| Enumeration Date | 2010-09-17 |
| Last Update Date | 2024-08-20 |