| NPI | 1073293775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL APRN11027433) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11027433) |
| Enumeration Date | 2023-07-19 |
| Last Update Date | 2026-05-08 |