| NPI | 1851952162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: AZ 230937) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AZ F06192632) |
| Enumeration Date | 2019-06-26 |
| Last Update Date | 2020-05-29 |