| NPI | 1366224263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL APRN11029181) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11029181) |
| Enumeration Date | 2023-10-16 |
| Last Update Date | 2026-04-16 |