| NPI | 1588332423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 305080) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ 132225) |
| Enumeration Date | 2021-09-04 |
| Last Update Date | 2024-07-19 |