| NPI | 1720742729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: AZ 268101) |
| Additional Taxonomies | 163WE0003X Registered Nurse Emergency (Licence: AZ RN185788) |
| Enumeration Date | 2021-10-26 |
| Last Update Date | 2022-02-11 |