| NPI | 1700201621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ AP5473) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: AZ AP5473) |
| 363LF0000X Nurse Practitioner Family (Licence: AZ AP5473) | |
| Enumeration Date | 2014-02-28 |
| Last Update Date | 2023-09-29 |