| NPI | 1649680554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: FL APRN11026608) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: VA 0024190981) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP125025) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 689063) | |
| Enumeration Date | 2014-04-30 |
| Last Update Date | 2025-11-21 |