| NPI | 1235504663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD R253041) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: DC NP1023532) |
| Enumeration Date | 2015-12-10 |
| Last Update Date | 2025-01-08 |