| NPI | 1912486523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ AP11644) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL F12170429) |
| Enumeration Date | 2018-08-14 |
| Last Update Date | 2018-08-14 |