| NPI | 1497375315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5013450) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 699254) |
| Enumeration Date | 2020-04-21 |
| Last Update Date | 2023-04-24 |