| NPI | 1982043758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP5148) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ rn128391) |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2024-08-14 |