| NPI | 1952893547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 256596) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IA 135989) |
| 363LF0000X Nurse Practitioner, Family (Licence: IA A135989) | |
| Enumeration Date | 2018-05-31 |
| Last Update Date | 2023-02-25 |