| NPI | 1316667025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024184972) |
| Additional Taxonomies | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: VA 0024184972) |
| 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: VA 0024184972) | |
| Enumeration Date | 2022-09-01 |
| Last Update Date | 2024-11-01 |