| NPI | 1932623469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP10396) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: AZ AP10396) |
| Enumeration Date | 2017-07-26 |
| Last Update Date | 2023-11-22 |