| NPI | 1013529791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: OK 106503) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OK R0106503) |
| Enumeration Date | 2020-08-23 |
| Last Update Date | 2021-10-11 |