| NPI | 1235185778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ZZ 242862) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP 9238727) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F304254) | |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2017-07-06 |