| NPI | 1922033943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP2736) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: AZ Rn113585) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2014-09-02 |