| NPI | 1629730189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 264882) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ Temp264882) |
| Enumeration Date | 2021-10-12 |
| Last Update Date | 2022-10-27 |