| NPI | 1689352767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ TEMP245660) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: AZ 245660) |
| Enumeration Date | 2023-07-07 |
| Last Update Date | 2023-07-26 |