| NPI | 1932675758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5011129) |
| Additional Taxonomies | 207RI0200X Internal Medicine, Infectious Disease (Licence: NC 5011129) |
| Enumeration Date | 2018-10-18 |
| Last Update Date | 2020-03-11 |