| NPI | 1356091565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: DC NP500004782) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MD R255211) |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2023-03-22 |