| 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 |