| NPI | 1790147056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MD R174875) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: MD R174875) |
| Enumeration Date | 2016-03-25 |
| Last Update Date | 2025-03-07 |