| NPI | 1225430705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: DC RN1019114) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: MD R212274) |
| 363LF0000X Nurse Practitioner Family (Licence: VA 0024171867) | |
| Enumeration Date | 2014-09-16 |
| Last Update Date | 2014-09-16 |