| NPI | 1881949188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP4567) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ TAP4567) |
| Enumeration Date | 2012-07-23 |
| Last Update Date | 2015-07-20 |