| NPI | 1427759521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11025053) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9468214) |
| 207R00000X Internal Medicine (Licence: FL 11025053) | |
| 208M00000X Hospitalist (Licence: FL 11025053) | |
| Enumeration Date | 2023-03-15 |
| Last Update Date | 2023-04-28 |