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 |