| NPI | 1912607839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 302928) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN191671) |
| Enumeration Date | 2023-03-08 |
| Last Update Date | 2024-03-27 |