NPI | 1245417492 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD R132556) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: DC RN965066) |
Enumeration Date | 2008-01-29 |
Last Update Date | 2017-03-02 |