| NPI | 1609502657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11035589) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL 11035589) |
| 363L00000X Nurse Practitioner (Licence: NY 355285) | |
| 207R00000X Internal Medicine (Licence: FL 11035589) | |
| 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: FL 11035589) | |
| 363L00000X Nurse Practitioner (Licence: AZ 314884) | |
| 363L00000X Nurse Practitioner (Licence: CA 95031847) | |
| Enumeration Date | 2022-07-30 |
| Last Update Date | 2025-09-16 |