| NPI | 1164075545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ 225509) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: AZ 225509) |
| Enumeration Date | 2019-07-24 |
| Last Update Date | 2023-10-27 |