| NPI | 1114317286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024172279) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: DC RN1052736) |
| Enumeration Date | 2015-01-28 |
| Last Update Date | 2019-05-20 |