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 |