| NPI | 1992258628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: VA 0024173701) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD R152787) |
| Enumeration Date | 2016-07-29 |
| Last Update Date | 2022-07-21 |