| NPI | 1053897033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024176314) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: VA 0024176314) |
| Enumeration Date | 2018-07-13 |
| Last Update Date | 2020-03-18 |