| NPI | 1962470963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: AZ RN076694) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ AZ AP 2229) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2011-12-15 |