| NPI | 1639173990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP0601) |
| Additional Taxonomies | 246QB0000X Spec/Tech, Pathology, Blood Banking |
| 246QM0706X Spec/Tech, Pathology, Medical Technologist | |
| 363LF0000X Nurse Practitioner, Family (Licence: WI 1306-033) | |
| Enumeration Date | 2005-06-02 |
| Last Update Date | 2013-05-10 |