| NPI | 1306590898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 147214) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9424246) |
| Enumeration Date | 2022-02-04 |
| Last Update Date | 2022-02-04 |