| NPI | 1972234334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine Cardiovascular Disease (Licence: FL APRN11018218) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: FL APRN11018218) |
| 363LF0000X Nurse Practitioner Family (Licence: FL 11018218) | |
| Enumeration Date | 2022-06-17 |
| Last Update Date | 2024-01-30 |