| NPI | 1154448520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: CA G52361) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA G52361) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2007-07-08 |