| NPI | 1780165852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5010891) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: NC 5010891) |
| Enumeration Date | 2018-08-27 |
| Last Update Date | 2024-07-15 |