| NPI | 1972064871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: CA 95010141) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95010141) |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2019-03-25 |