| NPI | 1912638487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 278544) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 11217804-3102) |
| 363LF0000X Nurse Practitioner, Family (Licence: UT 11217804-3102) | |
| Enumeration Date | 2022-06-23 |
| Last Update Date | 2022-08-23 |