| NPI | 1053711879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 5887) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 5587) |
| Enumeration Date | 2014-08-28 |
| Last Update Date | 2020-07-06 |