| NPI | 1700805801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA AP04296) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA AP04296) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2026-03-12 |