| NPI | 1407257546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: NC 5007153) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 5007153) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 5007153) | |
| Enumeration Date | 2014-09-09 |
| Last Update Date | 2023-12-18 |