| NPI | 1023661014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5012016) |
| Additional Taxonomies | 207RG0300X Internal Medicine Geriatric Medicine (Licence: NC 5012016) |
| Enumeration Date | 2019-07-19 |
| Last Update Date | 2024-07-15 |