| NPI | 1275893794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD R203089) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: DC RN1028060) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DC RN1028060) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R203089) | |
| Enumeration Date | 2012-05-17 |
| Last Update Date | 2020-08-20 |