| NPI | 1538480975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: VA 0024169123) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: MD R172720) |
| Enumeration Date | 2010-06-21 |
| Last Update Date | 2022-07-18 |