| NPI | 1912670282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11014618) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: FL APRN1014518) |
| Enumeration Date | 2021-07-31 |
| Last Update Date | 2025-01-31 |