| NPI | 1689655862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ARNP2164602) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP2164602) |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2012-05-14 |