| NPI | 1588182950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 14293005-4405) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WY 56782) |
| Enumeration Date | 2017-09-06 |
| Last Update Date | 2026-07-07 |