| NPI | 1669082970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: AZ RNP226242) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AZ RNP226242) |
| Enumeration Date | 2020-08-03 |
| Last Update Date | 2023-10-02 |