| NPI | 1952027880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL TRN44829) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11022389) |
| Enumeration Date | 2022-10-12 |
| Last Update Date | 2026-06-16 |