| NPI | 1942771597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: TX F11180287) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX F1180287) |
| Enumeration Date | 2018-12-07 |
| Last Update Date | 2022-10-07 |