| NPI | 1942049176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ RNP310638) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT F04240710) |
| Enumeration Date | 2024-05-20 |
| Last Update Date | 2024-10-25 |