| NPI | 1881186419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP11290) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ tap11290) |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2018-06-08 |