| NPI | 1972283208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 12185) |
| Additional Taxonomies | 207RN0300X Internal Medicine, Nephrology (Licence: CT 12185) |
| Enumeration Date | 2023-07-21 |
| Last Update Date | 2023-08-03 |