| NPI | 1710237425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5005802) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: NC 5005802) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 5005802) | |
| Enumeration Date | 2012-09-11 |
| Last Update Date | 2024-07-15 |