| NPI | 1124597661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024188682) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP138305) |
| 363LF0000X Nurse Practitioner, Family (Licence: DC NP500015050) | |
| Enumeration Date | 2018-11-14 |
| Last Update Date | 2024-01-26 |