| NPI | 1699747915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ AP5348) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NM R31638) |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2014-05-08 |