| NPI | 1629020912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP2354) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN073682) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2017-06-01 |