| NPI | 1629059241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: AZ AP5944) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: AZ RN096867) |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2019-12-01 |