| NPI | 1164427712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024165254) |
| Additional Taxonomies | 207RS0012X Internal Medicine, Sleep Medicine (Licence: VA 0024165254) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2023-11-27 |