| NPI | 1982263760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: FL APRN11001318) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11001318) |
| 207R00000X Internal Medicine (Licence: FL APRN11001318) | |
| Enumeration Date | 2019-06-06 |
| Last Update Date | 2021-09-15 |