| NPI | 1659756542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: AZ AP7963) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP7963) |
| Enumeration Date | 2015-07-21 |
| Last Update Date | 2025-08-13 |