NPI | 1043889355 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NM 63969) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM 63969) |
Enumeration Date | 2021-06-21 |
Last Update Date | 2024-02-29 |