| NPI | 1235884040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: TX 1030504) |
| Additional Taxonomies | 207RG0100X Internal Medicine Gastroenterology (Licence: TX 1030504) |
| Enumeration Date | 2022-02-21 |
| Last Update Date | 2022-04-22 |