| NPI | 1538784558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ID 67270) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: ID 67270) |
| 208M00000X Hospitalist (Licence: ID 1538784558) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-06-15 |
| Last Update Date | 2022-06-21 |