| NPI | 1629308051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ AP3503) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: AZ AP3503) |
| Enumeration Date | 2010-01-07 |
| Last Update Date | 2016-08-25 |