| NPI | 1063979128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5011498) |
| Additional Taxonomies | 207RP1001X Internal Medicine Pulmonary Disease (Licence: NC 5011498) |
| 207RS0012X Internal Medicine Sleep Medicine (Licence: NC 5011498) | |
| 363LP2300X Nurse Practitioner Primary Care (Licence: NC 5011498) | |
| Enumeration Date | 2019-02-25 |
| Last Update Date | 2023-12-19 |