| NPI | 1386128437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: VA 0024186021) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: DC RN1049263) |
| 363LA2100X Nurse Practitioner Acute Care (Licence: DC RN1049263) | |
| Enumeration Date | 2018-09-24 |
| Last Update Date | 2023-01-23 |