| NPI | 1194117846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: DC RN965336) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MD R152306) |
| Enumeration Date | 2015-03-03 |
| Last Update Date | 2021-06-01 |