| NPI | 1174184519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 22739) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 22739) |
| Enumeration Date | 2019-06-26 |
| Last Update Date | 2021-06-30 |