| NPI | 1548949431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: NC 5018438) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 5018438) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 5018438) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: NC 5018438) | |
| Enumeration Date | 2023-07-17 |
| Last Update Date | 2023-12-18 |