| NPI | 1790326353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 8273152-8900) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ 233616) |
| 163WE0003X Registered Nurse, Emergency (Licence: AZ RN178632) | |
| Enumeration Date | 2019-10-04 |
| Last Update Date | 2023-02-01 |