| NPI | 1104495894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024180593) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0024180593) |
| Enumeration Date | 2021-06-18 |
| Last Update Date | 2023-08-08 |