| NPI | 1851394183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP0111) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ RN033784) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2020-09-30 |