| NPI | 1245776814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 5009206) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 5009206) |
| 363LF0000X Nurse Practitioner, Family (Licence: NC 5009206) | |
| Enumeration Date | 2017-01-06 |
| Last Update Date | 2025-09-17 |