| NPI | 1235938994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: DC NP500341656) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2368295) |
| 163W00000X Registered Nurse (Licence: DC RN500341656) | |
| Enumeration Date | 2025-03-13 |
| Last Update Date | 2026-05-19 |