| NPI | 1417405143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: DC RN1060323) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MA RN2296602) |
| Enumeration Date | 2016-09-11 |
| Last Update Date | 2023-12-27 |