| NPI | 1477027415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN219668) |
| Additional Taxonomies | 207RC0000X Internal Medicine Cardiovascular Disease (Licence: GA RN219668) |
| Enumeration Date | 2019-01-13 |
| Last Update Date | 2024-10-03 |