| NPI | 1992295000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ 225061) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ RN183469) |
| Enumeration Date | 2018-05-14 |
| Last Update Date | 2019-04-22 |