| NPI | 1649768920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN236766) |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: GA RN236766) |
| Enumeration Date | 2018-04-23 |
| Last Update Date | 2023-07-17 |