| NPI | 1275917577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MD R181376) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: DC RN1016225) |
| 363LF0000X Nurse Practitioner, Family (Licence: MD R181376) | |
| Enumeration Date | 2015-07-16 |
| Last Update Date | 2015-09-04 |