| NPI | 1912256256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP7707) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: AZ AP7707) |
| Enumeration Date | 2012-08-31 |
| Last Update Date | 2026-03-30 |