| 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 |