| NPI | 1215306659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: DC RN1021272) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MD R183660) |
| 363LF0000X Nurse Practitioner, Family (Licence: VA 0024173078) | |
| Enumeration Date | 2015-09-16 |
| Last Update Date | 2024-05-10 |