| NPI | 1104533892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN250185) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: GA RN250185) |
| Enumeration Date | 2022-11-01 |
| Last Update Date | 2023-07-05 |