| NPI | 1699197426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5007140) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP#5382) |
| Enumeration Date | 2014-01-14 |
| Last Update Date | 2018-03-17 |