| NPI | 1003973397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM NM81-77) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: NM CNP-01651) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2025-03-05 |