| NPI | 1265602353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MT NUR-APRN-LIC-101945) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: MT 101945) |
| Enumeration Date | 2008-03-05 |
| Last Update Date | 2021-08-30 |