NPI | 1184217085 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 290011) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA 290011) |
Enumeration Date | 2021-02-11 |
Last Update Date | 2024-03-13 |