| NPI | 1710282629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: PA SP033250) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA SP033250) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: CA NP 19248) | |
| Enumeration Date | 2011-01-24 |
| Last Update Date | 2026-04-29 |