| NPI | 1255325833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9198618) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ARNP9198618) |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2016-01-26 |