| NPI | 1821243692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP3210) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NM 75731) |
| Enumeration Date | 2008-11-20 |
| Last Update Date | 2024-01-29 |