| NPI | 1013595065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA RN228420) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN228420) |
| 363LF0000X Nurse Practitioner Family (Licence: GA RN228420) | |
| Enumeration Date | 2021-03-31 |
| Last Update Date | 2024-04-04 |