| NPI | 1962751545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 224965) |
| Additional Taxonomies | 163WP2201X Registered Nurse, Ambulatory Care (Licence: AZ RN174273) |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2019-04-25 |