| NPI | 1972573384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ AP0620) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AZ RN043042) |
| 363L00000X Nurse Practitioner (Licence: HI RN-26058) | |
| 363L00000X Nurse Practitioner (Licence: CA 345776) | |
| 363LF0000X Nurse Practitioner, Family (Licence: AZ RN043042) | |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2018-05-29 |