| NPI | 1245502889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: DC RN1009677) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R181061) |
| 163W00000X Registered Nurse (Licence: DC RN1009677) | |
| Enumeration Date | 2012-01-28 |
| Last Update Date | 2015-02-13 |