| NPI | 1811420755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP10031) |
| Additional Taxonomies | 163WW0000X Registered Nurse, Wound Care (Licence: AZ AP10031) |
| Enumeration Date | 2017-04-07 |
| Last Update Date | 2020-03-26 |