| NPI | 1790333706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: AZ 265870) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NV 840311) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: ME CNP201002) | |
| 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: ME CNP201002) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN11003912) | |
| Enumeration Date | 2019-09-03 |
| Last Update Date | 2022-11-18 |