| NPI | 1265443063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS r851134) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS R851134) |
| 207R00000X Internal Medicine (Licence: MS R851134) | |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2022-07-18 |