| NPI | 1235418385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL MD.50386) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AL MD.50386) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: IL 209008978) | |
| Enumeration Date | 2011-08-08 |
| Last Update Date | 2025-01-03 |