| NPI | 1073158630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 26823) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: FL APRN11006396) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11006396) | |
| Enumeration Date | 2019-11-07 |
| Last Update Date | 2021-06-09 |