| NPI | 1184685687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 201895) |
| Additional Taxonomies | 207RC0000X Internal Medicine Cardiovascular Disease (Licence: NC 201895) |
| Enumeration Date | 2006-04-01 |
| Last Update Date | 2020-10-25 |