| NPI | 1225531429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024175583) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: DC RN1047450) |
| Enumeration Date | 2018-03-14 |
| Last Update Date | 2022-11-10 |