| NPI | 1487876421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MD AC000874) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: LA RN109429AP04458) |
| 363LA2200X Nurse Practitioner Adult Health (Licence: VA 0024166790) | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2017-07-20 |