| NPI | 1013399310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD R257465) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IA A128989) |
| 363LF0000X Nurse Practitioner, Family (Licence: DC RN1034280) | |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2023-03-03 |