| NPI | 1184335085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 287253) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ 287253) |
| Enumeration Date | 2022-12-12 |
| Last Update Date | 2025-09-04 |