| NPI | 1083487722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 34889) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: TN 34889) |
| Enumeration Date | 2023-11-03 |
| Last Update Date | 2025-10-31 |