| NPI | 1932173127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP2115) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: AZ RN103251) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2022-05-23 |