| NPI | 1174979587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: VA 0024175434) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD AC004504) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: GA RN228237) | |
| Enumeration Date | 2016-05-05 |
| Last Update Date | 2024-05-21 |