| NPI | 1619687167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: VA 0024184925) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024184925) |
| 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: VA 0024184925) | |
| Enumeration Date | 2022-11-23 |
| Last Update Date | 2025-02-26 |