| NPI | 1851259071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 34168) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 41251) |
| Enumeration Date | 2026-01-15 |
| Last Update Date | 2026-07-18 |