| NPI | 1568028082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: VA 0024177580) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: VA 0024177580) |
| Enumeration Date | 2019-05-10 |
| Last Update Date | 2019-10-29 |