| NPI | 1740827252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: AZ 224139) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 224139) |
| Enumeration Date | 2019-12-03 |
| Last Update Date | 2024-07-11 |