| NPI | 1275100372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: DC NP1051903) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: MD R231719) |
| 363LF0000X Nurse Practitioner Family (Licence: HI APRN-3204) | |
| Enumeration Date | 2021-06-07 |
| Last Update Date | 2023-08-23 |