| NPI | 1740842376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11024674) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 000235-P.A.) |
| Enumeration Date | 2019-07-03 |
| Last Update Date | 2023-11-17 |