| NPI | 1790251197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11000083) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 9310265) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: FL 608482) | |
| Enumeration Date | 2018-10-23 |
| Last Update Date | 2023-06-16 |