| NPI | 1215442223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: FL APRN9337478) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9337478) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN9337478) | |
| Enumeration Date | 2017-12-13 |
| Last Update Date | 2021-12-07 |