| NPI | 1609503275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11020346) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: FL APRN11020346) |
| Enumeration Date | 2022-08-04 |
| Last Update Date | 2023-08-28 |