| NPI | 1174981450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MT 88124) |
| 363LF0000X Nurse Practitioner, Family (Licence: MT NUR-APRN-LIC-102167) | |
| Enumeration Date | 2016-02-02 |
| Last Update Date | 2023-08-29 |