| NPI | 1992888952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP2497) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ RN121756) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2015-09-17 |