| NPI | 1740604487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ AP5398) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP5398) |
| Enumeration Date | 2014-02-18 |
| Last Update Date | 2022-06-15 |