| NPI | 1134626302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD R191086) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: DC RN1019897) |
| Enumeration Date | 2018-04-12 |
| Last Update Date | 2019-10-28 |