| NPI | 1942618731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: AZ AP5737) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: AZ AP5737) |
| 363LP2300X Nurse Practitioner Primary Care (Licence: AZ AP5737) | |
| Enumeration Date | 2014-07-24 |
| Last Update Date | 2024-08-22 |