| NPI | 1629471412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP 7468) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NM CNP-02553) |
| 363LF0000X Nurse Practitioner, Family (Licence: MO 2014034806) | |
| Enumeration Date | 2014-10-07 |
| Last Update Date | 2026-03-31 |