| NPI | 1326750563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN259670) |
| Additional Taxonomies | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: GA RN259670) |
| Enumeration Date | 2022-12-20 |
| Last Update Date | 2023-06-15 |