| NPI | 1861582447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ 291176) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: UT 374115-4408) |
| 363L00000X Nurse Practitioner (Licence: NV APRN002370) | |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2023-08-22 |