| NPI | 1629630595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP020425) |
| Additional Taxonomies | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: PA SP020425) |
| Enumeration Date | 2019-07-01 |
| Last Update Date | 2020-08-30 |